Multivariate analysis of clinical and radiological risk factors for revision endoscopic sinus surgery in patients with chronic rhinosinusitis with nasal polyps: can phenotype predict recurrence?

OBJECTIVE: This study aimed to analyse clinical and radiological features (phenotypes) to predict revision risk after functional endoscopic sinus surgery in patients with chronic rhinosinusitis with nasal polyps. METHOD: Phenotype characteristics of the patients with chronic rhinosinusitis with nasal polyps who underwent functional endoscopic sinus surgery were analysed retrospectively. RESULTS: The rates of asthma, aspirin sensitivity, smoking and a positive prick test result were significantly higher in revision functional endoscopic sinus surgery cases (p < 0.001, 0.001, < 0.001 and < 0.001, respectively). Multivariate analysis demonstrated that only gender, pre-operative nasal steroid use, pre-operative systemic steroid use, intra-operative systemic steroid use and smoking were significant risk factors for revision functional endoscopic sinus surgery (p = 0.034, 0.001, 0.010, 0.007 and 0.001, respectively). In addition, only eosinophilia and aspirin sensitivity were significant risk factors for multiple revision functional endoscopic sinus surgery procedures (p = 0.043 and 0.005, odds ratio = 2.4 and 5.2). CONCLUSION: Beyond the endotype of chronic rhinosinusitis with nasal polyps, defining clinical and radiological factors enables a valid prediction of patients at high risk of revision functional endoscopic sinus surgery.

Strain Echocardiographic Evaluation of Myocardial Involvement in Patients with Continuing Chest Pain after COVID-19 Infection. / Avaliação Ecocardiográfica com Strain do Envolvimento Miocárdico em Pacientes com Dor Torácica Contínua após Infecção por COVID-19.

BACKGROUND: A new clinical manifestation called post or long coronavirus disease (p/l COVID) has walked into our lives after the acute COVID-19 phase. P/l COVID may lead to myocardial injury with subsequent cardiac problems. Diagnosing these patients quickly and simply has become more important due to the increasing number of patients with p/l COVID. OBJECTIVES: We compared strain echocardiography (SE) parameters of patients who suffered from atypical chest pain and had sequel myocarditis findings on cardiac magnetic resonance (CMR). We aimed to investigate the value of SE for detection of myocardial involvement in patients with p/l COVID. METHODS: A total of 42 patients were enrolled. Our population was separated into two groups. The CMR(-) group (n = 21) had no myocardial sequelae on CMR, whereas the CMR(+) group had myocardial sequelae on CMR (n = 21). The predictive value of SE for myocarditis was also evaluated by age-adjusted multivariate analysis. P values < 0.05 were considered statistically significant. RESULTS: When compared with left ventricular ejection fraction (LVEF), global longitudinal strain (GLS) and global circumferential strain (GCS) had a stronger relationship (LVEF, p = 0.05; GLS, p < 0.001; GCS, p < 0.001) with p/l COVID associated myocardial involvement. GLS < 20.35 had 85.7% sensitivity and 81% specificity; GCS < 21.35 had 81% sensitivity and 81% specificity as diagnostic values for myocardial sequelae detected with CMR. While there was no difference between the groups in terms of inflammatory markers (C-reactive protein, p = 0.31), a difference was observed between biochemical markers, which are indicators of cardiac involvement (brain natriuretic peptide, p < 0.001). CONCLUSION: SE is more useful than traditional echocardiography for making diagnosis quickly and accurately in order not to delay treatment in the presence of myocardial involvement.

FUNDAMENTO: Tem surgido uma nova manifestação clínica chamada pós-COVID ou COVID longa (COVID p/l) após a fase aguda da COVID-19. COVID p/l pode levar à lesão miocárdica com problemas cardíacos subsequentes. Diagnosticar esses pacientes de forma rápida e simples é cada vez mais importante devido ao número crescente de pacientes com COVID p/l. OBJETIVOS: Comparamos os parâmetros de ecocardiografia com strain (ES) de pacientes que apresentaram dor torácica atípica e achados de sequelas de miocardite na ressonância magnética cardíaca (RMC). Nosso objetivo foi investigar o valor da ES para detecção de envolvimento miocárdico em pacientes com COVID p/l. MÉTODOS: Foram incluídos um total de 42 pacientes. Nossa população foi separada em 2 grupos. O grupo RMC(-) (n = 21) não apresentou sequelas miocárdicas na RMC, enquanto o grupo RMC(+) apresentou sequelas miocárdicas na RMC (n = 21). O valor preditivo da ES para miocardite também foi avaliado por análise multivariada ajustada por idade. Valores de p < 0,05 foram considerados estatisticamente significativos. RESULTADOS: Quando comparado com a fração de ejeção do ventrículo esquerdo (FEVE), o strain longitudinal global (SLG) e o strain circunferencial global (SCG) tiveram uma relação mais forte (FEVE, p = 0,05; SLG, p < 0,001; SCG, p < 0,001) com envolvimento miocárdico associado à COVID p/l. SLG < 20,35 apresentou sensibilidade de 85,7% e especificidade de 81%; SCG < 21,35 apresentou sensibilidade de 81% e especificidade de 81% como valores diagnósticos para sequelas miocárdicas detectadas com RMC. Enquanto não houve diferença entre os grupos quanto aos marcadores inflamatórios (proteína C-reativa, p = 0,31), houve diferença entre os marcadores bioquímicos, que são indicadores de envolvimento cardíaco (peptídeo natriurético cerebral, p < 0,001). CONCLUSÃO: A ES é mais útil do que a ecocardiografia tradicional para diagnosticar com rapidez e precisão, a fim de não atrasar o tratamento na presença de envolvimento miocárdico.

A retrospective magnetic resonance imaging analysis of bone and soft tissue changes associated with the spectrum of tarsal coalitions.

We aimed to investigate the bone and soft tissue changes accompanying tarsal coalition (TC) and aimed to evaluate their association with the location and type of coalition. Ankle magnetic resonance imagings of 65 patients with TC were included. The relationship between the location and type of coalition and bone marrow edema, subchondral cysts, sinus tarsi syndrome, tarsal tunnel syndrome, posterior impingement syndrome, accessory bone, tibiotalar effusion, talar osteochondritis dissecans, ganglion cysts, and calcaneal spur were evaluated. Twenty-nine patients without coalition were selected as the control group, and the distribution of these variables between the two groups was analyzed. There were 33 females and 32 males in the coalition group (mean age: 42.0 ± 15.63 years), and 22 females and seven males in the control group (mean age: 44.79 ± 12.33 years). Coalition was most common in the talocalcaneal joint (n = 33, 50.8%), and the most common coalition type was non-osseous (n = 57, 87.6%). We find no significant difference between the pathologies defined in terms of coalition location and type. Sinus tarsi syndrome, tarsal tunnel syndrome, subchondral cysts, and tibiotalar effusion were found to be more common in the coalition group (p = 0.028, p = 0.010, p = 0.023, and p = 0.006, respectively). The presence of coalition increased the probability of developing tarsal tunnel syndrome 9.91 times (95% CI: [1.25-78.59]; p = 0.029), and sinus tarsi syndrome 3.66 times (95% CI: [1.14-11.78]; p = 0.029). Tarsal coalition may predispose bone and soft tissue changes. In this study, sinus tarsi syndrome, tarsal tunnel syndrome, subchondral cysts and tibiotalar effusion were found to be more common in the coalition group.

Avaliação Ecocardiográfica com Strain do Envolvimento Miocárdico em Pacientes com Dor Torácica Contínua após Infecção por COVID-19 / Strain Echocardiographic Evaluation of Myocardial Involvement in Patients with Continuing Chest Pain after COVID-19 Infection

Resumo Fundamento Tem surgido uma nova manifestação clínica chamada pós-COVID ou COVID longa (COVID p/l) após a fase aguda da COVID-19. COVID p/l pode levar à lesão miocárdica com problemas cardíacos subsequentes. Diagnosticar esses pacientes de forma rápida e simples é cada vez mais importante devido ao número crescente de pacientes com COVID p/l. Objetivos Comparamos os parâmetros de ecocardiografia com strain (ES) de pacientes que apresentaram dor torácica atípica e achados de sequelas de miocardite na ressonância magnética cardíaca (RMC). Nosso objetivo foi investigar o valor da ES para detecção de envolvimento miocárdico em pacientes com COVID p/l. Métodos Foram incluídos um total de 42 pacientes. Nossa população foi separada em 2 grupos. O grupo RMC(-) (n = 21) não apresentou sequelas miocárdicas na RMC, enquanto o grupo RMC(+) apresentou sequelas miocárdicas na RMC (n = 21). O valor preditivo da ES para miocardite também foi avaliado por análise multivariada ajustada por idade. Valores de p < 0,05 foram considerados estatisticamente significativos. Resultados Quando comparado com a fração de ejeção do ventrículo esquerdo (FEVE), o strain longitudinal global (SLG) e o strain circunferencial global (SCG) tiveram uma relação mais forte (FEVE, p = 0,05; SLG, p < 0,001; SCG, p < 0,001) com envolvimento miocárdico associado à COVID p/l. SLG < 20,35 apresentou sensibilidade de 85,7% e especificidade de 81%; SCG < 21,35 apresentou sensibilidade de 81% e especificidade de 81% como valores diagnósticos para sequelas miocárdicas detectadas com RMC. Enquanto não houve diferença entre os grupos quanto aos marcadores inflamatórios (proteína C-reativa, p = 0,31), houve diferença entre os marcadores bioquímicos, que são indicadores de envolvimento cardíaco (peptídeo natriurético cerebral, p < 0,001). Conclusão A ES é mais útil do que a ecocardiografia tradicional para diagnosticar com rapidez e precisão, a fim de não atrasar o tratamento na presença de envolvimento miocárdico.

Abstract Background A new clinical manifestation called post or long coronavirus disease (p/l COVID) has walked into our lives after the acute COVID-19 phase. P/l COVID may lead to myocardial injury with subsequent cardiac problems. Diagnosing these patients quickly and simply has become more important due to the increasing number of patients with p/l COVID. Objectives We compared strain echocardiography (SE) parameters of patients who suffered from atypical chest pain and had sequel myocarditis findings on cardiac magnetic resonance (CMR). We aimed to investigate the value of SE for detection of myocardial involvement in patients with p/l COVID. Methods A total of 42 patients were enrolled. Our population was separated into two groups. The CMR(-) group (n = 21) had no myocardial sequelae on CMR, whereas the CMR(+) group had myocardial sequelae on CMR (n = 21). The predictive value of SE for myocarditis was also evaluated by age-adjusted multivariate analysis. P values < 0.05 were considered statistically significant. Results When compared with left ventricular ejection fraction (LVEF), global longitudinal strain (GLS) and global circumferential strain (GCS) had a stronger relationship (LVEF, p = 0.05; GLS, p < 0.001; GCS, p < 0.001) with p/l COVID associated myocardial involvement. GLS < 20.35 had 85.7% sensitivity and 81% specificity; GCS < 21.35 had 81% sensitivity and 81% specificity as diagnostic values for myocardial sequelae detected with CMR. While there was no difference between the groups in terms of inflammatory markers (C-reactive protein, p = 0.31), a difference was observed between biochemical markers, which are indicators of cardiac involvement (brain natriuretic peptide, p < 0.001). Conclusion SE is more useful than traditional echocardiography for making diagnosis quickly and accurately in order not to delay treatment in the presence of myocardial involvement.

COVID-19 myocarditis cardiac magnetic resonance findings in symptomatic patients.

BACKGROUND: Coronavirus disease 2019 (COVID-19) may cause myocardial damage. PURPOSE: To evaluate the short-term and medium-term results, as well as the imaging features of COVID-19 cardiac involvement, using cardiac magnetic resonance (CMR). MATERIAL AND METHODS: In this study, laboratory and CMR findings of 15 patients with COVID-19 between May 2020 and May 2021 were evaluated retrospectively. Late gadolinium enhancement (LGE) imaging was evaluated for myocarditis. Cardiac functions were quantitatively evaluated and compared to the control patient group. High-sensitivity cardiac troponin I (Hs-cTnI), C-reactive protein (CRP) exchange, and LGE were compared. RESULTS: Fifteen patients (7 women; mean age = 38 years) were evaluated. Six patients were treated at home, while nine patients were treated in the hospital. The patients were given remdesivir and hydroxychloroquine treatment. LGE was detected in 2 (33%) patients treated at home and 5 (55.5%) patients treated in the hospital. In hospitalized patients, levels of Hs-cTnI (mean = 7.8 pg/mL) and CRP (mean = 32.3 mg/L) were elevated. A high correlation was observed between the increase in Hs-cTnI value and LGE (r = 0.63; P < 0.001). A low correlation was observed between an increase in CRP and LGE (r = 033; P < 0.001). There was no statistically significant difference in ventricular functions between the COVID-19 and control groups (P < 0.001). CONCLUSION: CMR abnormalities were found in a high percentage (46%) of patients with COVID-19. Myocardial abnormalities in patients with COVID-19 can be detected by CMR. For COVID-19 myocarditis, no specific diagnostic CMR imaging feature was observed.

Prognostic Value of Standard Coronary Computed Tomography Angiography Reporting System (CAD-RADS).

Aims This study evaluated the clinical prospects of Coronary Artery Disease-Reporting and Data System (CAD-RADS) scoring in coronary computed tomography angiography (CTA). The aim of the study was to determine the guidance value of CAD-RADS scoring in patient follow-up after CTA. Methods and Materials Reports of cases reported between 2010 and 2013 were reevaluated with CAD-RADS scoring. Clinical risk analysis was performed with initial forms of anamnesis. Clinical follow-up was performed on 7 to 10 years (mean: 8 years, 4 months) hospital records. Univariate and multivariate Cox modeling was performed with Kaplan-Meier method to define the relationship between clinical (age, gender, diabetes mellitus, hypertension, smoking, family history) and CAD-RADS variables, and for risk analysis based on these causes. Cox proportional-hazards analysis results were presented as a hazard ratio with a 95% confidence interval. CAD-RADS scores were evaluated as meaningful determinants of univariate and multivariate Cox proportional survival analysis. Results Totally, 359 cases were evaluated in the study. Severe coronary pathology development rate was observed as CAD-RADS 0to 1%, CAD-RADS 1 to 3%, CAD-RADS 2 to 4%, CAD-RADS 3 to 9%, CAD-RADS 4A to 21%, 4B to 25%, CAD-RADS 5 to 50%. There were no coronary artery deaths in CAD-RADS 1,2,3 cases in 10 years of follow-up. Two cases with CAD-RADS 4 A score, three cases with 4 B score, and four patients with CAD-RADS 5 had a history of death as a result of coronary disease. Conclusions The cases with a high risk of side effects with CAD-RADS scores were clearly shown. CAD-RADS score accurately identifies risks in postimaging follow-up and is a reliable reporting system in the required treatment planning.

Imaging of Aberrant Internal Carotid Arteries.

OBJECTIVE: Aberrant internal carotid arteries (ICAs) may take abnormal courses in the cervical region. We present the ICA imaging features that suggest the presence of a submucosal mass in the posterior pharyngeal wall caused by such an aberration. METHODS: Cervical computed tomography angiography images of 2400 patients obtained over 5 years were retrospectively reviewed. The ICA courses at the levels of the hypopharynx and oropharynx were evaluated. Aberrant ICAs running posterior to the pharynx were selected. Vessel location was classified into 3 types: lateral to the vertebral foramen (normal, type I); between the lateral foramen and the uncovertebral joint (type II); and medial to the uncovertebral joint (type III). Medical records were examined, and relationships between symptoms, the ICA variations, and imaging features evaluated. RESULTS: Cervically aberrant ICAs of type II were detected in 45 patients and aberrations of type III in 18. In the latter group, the mean patient age was 66 years, 12 were men and 6 were women. Six (33%) patients (4 men) had clinical symptoms associated with their aberrant ICA courses. In 2 men (11%), both ICAs took aberrant courses. Otherwise, the right ICA was affected in 9 (50%) cases and the left ICA in 7 (39%). DISCUSSION: Parapharyngeal ICA aberrations were both common and asymptomatic. Such ICAs may be damaged during pharyngeal surgery or intubation. The ICA location should be investigated before any interventional procedure.

Isolated tympanic plate fracture frequency and its relationship to mandibular trauma.

PURPOSE: This study evaluated the prevalence of isolated tympanic fractures and their correlation with mandibular fractures by using maxillofacial computed tomography (CT). MATERIALS AND METHODS: We retrospectively evaluated the maxillofacial CT of 1590 patients who presented to our emergency department with maxillofacial trauma between December 2010 and December 2012. Maxillofacial CT was used as the criterion standard for evaluating patients with maxillofacial fractures. The CT images were evaluated by using an electronic picture archiving and communications system and interpreted independently by 2 radiologists. RESULTS: The maxillofacial CT images revealed mandibular fractures in 167 of the patients and isolated tympanic plate fractures in 35 of these 167 patients. Four patients (11%) had a bilateral tympanic plate fracture, and 31 patients (89%) had unilateral tympanic plate fracture. Of all the tympanic plate fractures, 19 (54%) were on the right side and 16 (46%) were on the left side (P > .05). In our results, a significant correlation between the presence of a right-sided tympanic plate fracture and fracture of the ipsilateral condylar process was found (P = .036). However, a statistically significant difference between the presence of a tympanic plate fracture and other mandible fractures, additional soft-tissue findings, or the number of fractures was not determined (P > .05). Sex had no impact on the presence of tympanic plate fracture (P > .05). CONCLUSION: The frequency of isolated tympanic plate fractures in maxillofacial trauma is low, but it is an important anatomic location. Condyle fractures are significantly associated with isolated tympanic plate fractures. The presence of these injuries should raise suspicion of a concomitant isolated tympanic plate fracture.

Computed tomography findings of an unusual maxillary sinus mass: brown tumor due to tertiary hyperparathyroidism.

Brown tumor is a non-neoplastic bone lesion that develops secondary to hyperparathyroidism and it is very rare in the maxillofacial region. We report the case of a 59-year-old man who presented with pain and a swelling in the left cheek. Computed tomography (CT) demonstrated an expansile and radioluscent lesion in the left maxillary sinus. Incisional biopsy was performed, and the diagnosis was Brown tumor. Brown tumor must be considered in the differential diagnosis of expansile lesions of maxillary sinus.